Note the first line in this journal article. The state medical society produced by-laws requiring that every county be reported on regarding medical topography and medical meteorology. This represents one of many such articles that appear in the medical journals during the early 1800s. Once the New York Medical Society took the initiative to redesign the focus on medical cartography and medical geography, Medical Repository became one of the major publishers of these reviews. The other United States medical journal important to this phase in American epidemiology history was the Philadelphia Medical and Physical Journal, published for just a few years.
In the following article, the author informs us that:
- “Marsh Miasmata” is the cause for diseases, which are of a bilious nature.
- The cause for this is “The scarcity of springs and running streams, as well as the dead creeks and extensive morasses which are scattered upon its eastern part near Lake Champlain, are, I imagine, but too productive of that never failing cause of bilious complaints, viz. marsh miasmata.”
Most importantly, an occupational disease could be identified and related to this medical geography–acute rheumatism in raft-makers brought on by long term immersion in water up to the knees or waste. This is one of the more unique parts of this writing. Suppositions of the same are seen with regard to poor hygiene and sanitation practices in relation to miasma and disease, or in the case of Samuel Mitchell’s teachings promoted at the same time– sepsis (nitrogen gas related to ammonia) and disease, produced by decaying foodstuffs, animal waste, slaughterhouse waste, etc..
This is one of numerous very important articles on the studies of disease published in the Medical Repository during its first few years. These articles relate health and disease to human population density, human filth and waste, and socioeconomic status.
An Account of the Diseases prevalent in Clinton County, New-York, during 1807.
By Dr. Horatio Powell, of Chazy. Read before the State Medical Society, and communicated to the Editors by the President.
BY an article in the Bye-Laws of this Society, it is a duty incumbent on every member, at the annual meeting, to present a topographical description of the county in which he resides, together with a history of its diseases and their methods of cure.
My residence in the county of Clinton has been so short, and my appointment as Delegate to this Sociery is so recent, that at this time it is impossible for me to bring before you the required topographical description.
I am likewise sensible, that my account of the diseases which have prevailed during the late season, and the methods of treatment pursued, in the northern part of this State, will be very imperfect. However, in obedience to the rule, I cheerfully submit it to your inspection.
Diseases of the last season have partaken almost universally of a bilious nature. This bilious diathesis, if I may so use the term, has been, I think with much reason, ascribed to the formation and local situation of this county. Its evenness is such as to render it almost perfectly level. The scarcity of springs and running streams, as well as the dead creeks and extensive morasses which are scattered upon its eastern part near Lake Champlain, are, I imagine, but too productive of that never failing cause of bilious complaints, viz. marsh miasmata.
During the months of April, May, June, and the beginning of July, the weather was unusually cool: in the two former months much rain fell; and the season, to use the expression of the farmers, was very backward.
In April, many in this vicinity were affected with acute rheumatism, coughs, and other inflammatory disorders. These patients, I observed, were principally amongst that class of people, who, for some time previous, had been several hours in each day immersed to their knees, and frequently to their waists, in the cold waters of the lake, for the purpose of making rafts of boards, and other lumber. Bloodletting, cooling cathartics, antimonials and sudorifics, were for the most part sufficient to work a cure.
In May and June the bilious remitting and intermitting fever prevailed very considerably ; few cases, however, proved fatal. The remitting fever was treated most successfully, by exhibiting early in the disease, one or more cathartics of calomel. Frequently it was necessary to combine jalap with the calomel. An emetic of tartarized antimony, more or less powerful, as the symptoms seemed to indicate, and in some cases, emetics occasionally repeated during the course of the disease, were highly useful. In all, the sp. mindereri, tartarized antimony, with laudanum, and the compound powder of ipecacuanha, after the first passages were sufficiently cleared, were serviceable.
In some cases, blisters and alterative doses of calomel were absolutely necessary ; and where calomel was used to such an extent as to produce a genuine ptyalism, our patients were certain to recover. I have nothing to observe respecting the diseases of the month of July ; for the inhabitants of this and the neighbouring towns were, during that time, almost universally healthy.
I now hasten to notice an epidemic, which, in the medical annals of this county, will be remembered for ages yet to come—the Influenza. Its first attacks in the vicinity of Chazy, were about the l0th of August. From whence this wide-spreading ailment originated ; or by what laws of nature or of the animal economy it traversed with such uninterrupted regularity this and the neighbouring States uniformly from south to north, I am not able to determine. From its extensive prevalence, it did not appear to be merely endemical; neither was it contagious: but doubtless was owing to a peculiar state of the atmosphere, which peculiar state is best known by referring to meteorological tables kept during the continuance of this memorable epidemic. Its symptoms were somewhat various. I shall, however, describe them as I wrote them down at that time in my journal.
” Patients for the most part, on the first attack, complained of being unusually chilly ; all the symptoms of a common cold, or coryza, soon came on. Their nostrils were completely stopped; they had an incessant tickling cough, head-ache, and dull, and sometimes inflamed eyes. In some, the pulses were soft; in others, hard and frequent: they soon lost their strength. In general the appetite tailed; some, however, continued to crave food as usual. Most commonly their bowels were in good order ; urine high coloured. Some sweated easily upon exertion ; others had their skin obstinately dry.”
Our treatment has been to exhibit emetics, nauseating medicines, venesection when the pulses are hard; the feet to be kept warm and the head cool.
On the 20th of August I had noted, ” the influenza is now very common. It is epidemic from New-York to Canada. Cathartics are in general useful; sweating is universally so.”
On the 6th of September I noted, ” This distemper still prevails: the coughing grows more obstinate, and of longer continuance.” On the llth of the same month I had observed: ” The influenza still rages. Many are at this time first seized with pain in one or both ears ; some with pain in one or more teeth, especially if any are carious ; and some are first affected with severe pain in the small of their back; others in the back part of their head, complaining that the tendons of their neck are sore. All complain of a disagreeable bitter taste in their mouth, especially on first awaking in the morning; and many speak of troublesome soreness at the diaphragm and parts adjacent, from the almost constant coughing to which they are subject. Cold feet are not an unfrequent symptom, whilst the head at the same time in some is extremely warm. Some patients are affected with severe chillness constantly for twenty-four hours, previous to any preternatural heat or fever.” About the middle of this month, this disease began to be less frequent; and by the first of October there was scarcely a case to be heard of. The prevailing diseases of the month of October were principally bilious, remitting, and intermitting fevers; not, however, very frequent nor alarming.
In November, a few, particularly of the younger class, and men in the prime of life, who were previously in perfect health, were invaded by inflammatory symptoms. Those who had made too free use of spirituous liquors, I believe, were most subject to those attacks. Bleeding, cooling cathartics, and antimonials, were sufficient to stop the progress of this disorder. A few severe cases of bilious remitting fever likewise occurred during this month.
In December, the inhabitants of this part of the country were, for the most part, healthy : though several cases of croup occurred amongst children under three years of age ; very few, however, proved fatal. Emetics of tartarized antimony, and cathartics of sub-muriate of mercury, followed by alterative doses of the same with tartarized antimony, when exhibited in season, effected a cure.
Clinton County Medical Geography
What are the medical geography features that stand out about Clinton County, New York?
This is a question that most doctors were asking between 1800 and 1860. Following the Civil War, medicine began an abrupt change in the philosophy of disease formation or pathogenesis. From about 1865 to 1875, medicine went back to its mixed philosophies of disease causes related to topography, weather, poor sanitation, natural forces, animalcules (by now microbial), personal habits and behaviors, contagion, electricity and galvanism (the direct current and controllable wave currents were by now introduced), and a mish mash of local ideologies and traditions pulled together to form the most recent popular culture beliefs. By 1875, the notion of bacterial disease and the need for sterilization processes (Lister) were beginning to gain attention. But it wouldn’t be for another 10 or 20 years before the older generation of practitioners could die off, leaving behind the first generation of older physicians who believed in the new germ theory of disease. It would be until about 1890 that most regular doctors adhered primarily to the germ theory, and slowly began to leave behind the climate and topographic theories of disease that controlled much of the medical disciplines from 1790 to the late 19th century.
The location of Clinton County in a geographical sense made it a very unique county to study and publish the medical geography for. It was located at the northmost edge of the state of New York, its eastern border was formed by a massive water body, providing it with some of the lakeside effects seen in other parts of New York adjacent to the Great Lakes, but not the same wind effect seen in these lakeside counties further west. There was no lake effect winds and show for the residents to contend with, except for the less common east-to-west lakeshore effect. So the primary topographical features impact Clinton County disease were lakeshore effects with winds, and mountain effects induced by the Adirondacks to the west.
The Adirondacks provided a completely different profile for how coldness impacts people and disease patterns. Being at the northern edge of New York, Clinton County was already susceptible to some diseases that physicians considered atypical of the much warmer settings down to the south adjacent to New York City and Westchester County. The primary example of such conditions pertains to “colds” and influenza. The first was a catarrhal disease brought about by the uncomfortable, cold air that one often had to face. The second was a much worse form of the catarrh in which there was total involvement of the lungs, sinuses and naval cavities. These two diseases, considered to be one and the same but of different severity to some, were the major epidemic problem for this part of New York.
The second type of disease common to this region but not unique was the fever. But realize, the fever is best considered a symptom of a disorder, which during the early 19th century had not yet been defined. So another question arises regarding the febrile disease patterns the author presented us with. Powell’s discussion of the fevers focuses on the bilious fever. The bilious fever, if we try to identify it based upon tradition early 19th century medical philosophy, perhaps refers to yellow fever, a mosquito spread condition which has the effect of causing biliary like symptoms in a person. The yellow fever is introduced to regions via shipping industries–usually infected passengers bring it in with them but the ships as well can carry the required virus-infected mosquito in barrel or ballast waters capable of spreading this disease into the local environment and to new people–but it is very cold in Clinton County, generally speaking, reducing the likelihood that this fever will become something very continuous and recurring, and endemic in nature for the region.
But there are also intermittent and remitting fevers that Powell briefly mentions. Intermittent fevers bear a cyclic pattern for the fever and sweats or ague, remitting fevers bear a less obvious fvorm of cyclicity. For the most part, both of these are related to malaria, which like the yellow fever is a disease passed on by mosquitoes. Both yellow fever and malaria are ecologically bred in warm tropical settings, and brought up into Clinton County by ship, and almost always during the warmest time of the year. So the possibility of recurring epidemics of each of these exists for Clinton County, with the expectation that this disease will go away once the season ends.
Likewise, other diseases brought in by ships such as ship fever or typhoid are expected to create havoc with public health in much the same way as yellow fever and malaria. The spotted fever (dengue) as well will carry on this same epidemic, non-endemic behavior.
Referring all of this back to Powell’s discussion of locally endemic diseases, only the eastern portion of Clinton County immediately adjacent to the Lake has the “marsh miasmata” required for fever propagation. As one heads westward towards to Adirondacks, changes in slope, soil type, geology, elevation and local weather and climate make this fairly active setting for water, with rapidly flowing streams and few marshes, thereby making this region to other non-miasmic induced diseases diseases. The possibilities he mentions for these disease are: acute rheumatism, coughs, and other inflammatory disorders, influenza, and the common cold or coryza. The bulk of these cases could be attributable to two other major weather features for this region: cold climates, and wind.
We see this in the following examples of major physiographic and climatic features related to Clinton County.
Snow fall behaviors in the Adirondacks, 13 Mar 2005
Lakeshore Environments
Lake Chazy
Lake Chazy Island Home
Wind farms
Human Geography and Medicine
The human part of this story of the geography of Clinton County relative to its local health history is still true today. As a part of its nineteenth century history, this study focused on the healthy impacts of lakes upon health and the roles that unique topographic settings sometimes played in defining the local medical history. Even during the earliest years of its settlement after the Revolutionary War, the lakeshores in Clinton County were popular vacation spots for tourism, which were often marketed as places to better your physical health and assist you in your recovery from such diseases as rheumatism, ascites, pleurisy, gout, and the most deadly of diseases for the time, consumption. This belief was especially adhered to especially by people with lung and joint afflictions. By the end of the 19th century, we still see these behaviors taking place. People with tuberculosis opted to spend a certain number of days per year in the lower humidity settings of this region, compared with the lower Hudson Valley and New York City settings. The cleaner, crisper air of this region made it an essential part of activities engaged in by most valetudinarian and sanitarian worshippers. Thus it was not uncommon for these patients to go to high elevation settings like the nearby Adirondacks in order to spend a significant amount of time in some sort of cabin or camp setting. Since people with rheumatism tended to suffer greatly from humidity, they too opted to stay away from the Lake Champlain and Lake Dannemora settings, looking for higher elevation settings to retreat into.
Topographic features like caves and in the case of Clinton County, the Ausable Chasm, were often provided unique attributes regarding disease treatment activities. One treatment for tuberculosis potentially applicable to the chasm setting is spending time in such settings, again to treat tuberculosis. The healthier chasm air was the attractant in this case; in other parts of the country, this same claim would be made for places where chemically-rich airs were formed and released in these types of settings, like the sulphur rich air of some caves close to oil and coal mine settings.
The Current Clinton County
Thruway 87 to Plattsburgh, east of Ausable Town
Unique Demographics and Topography around Ausable
The Famous Visitor’s Center at Ausable chasm
Population, Income and Health
In 1999/2000, I did a population health and foodways review of the New York area extending from New York City to Clinton County. The purpose of this project was to obtain a better idea about the market trends for this region, its economic patterns and stability, and the relation of these to population density and travel routes. Due to the kinds of information available to me at the time for this study, in order to better understand the changing economy of this part of the state, I analyzed food service businesses between central New York City and Clinton County. These food service industries included fast food restaurants, regular family dining places, and specialty restaurants.
Several thousand restaurants were identified along the tourist route heading from New York City to the Canadian Border. The most prevalent fast food business along this route was the pizzaria. I also reviewed family dining facilities and had available to me data to review defining average restaurant cost for a given meal type, according to the Harris Business Index data. The meal studies for this county to county cost analysis was average breakfast cost, with two eggs, some protein side, hashbrowns, and coffee. What I found was that the average county costs for these goods nearly tripled once one left New York City proper, and continued along the northway into Clinton County. Next to Lake Champlain, the average cost for a breakfast was more than twice that of a Westchester County community dining place like in Hawthorne or Rye. The proximity to Lake Champlain and the nearby outdoor facilities for tourism made this a “hot spot” for tourists and outdoor recreationists. When this data was compared with average income census data along the same route, using census data provided at the county level, it was found that there was a sort of target like effect on income distributions ,with exceptionally low income levels in downtown New York, significantly larger income levels in Westchester Counties, followed by a low income until Dutchess County was reached, followed by even more of a decline in income as one progressed from Dutchess County northward. The lowest income area in the state, county wise, was in the heart of the Adirondacks just west of Clinton County; it was less than $5000. This part of the state also had the lowest savings per family (<$200), but with a sizable acreage per family value and land use identifier–these low income families also possessed sizable tracts of land (several acres per family), enough land to own and operate self-sustaining farms.
If we relate these findings to population health and disease, we find a likelihood for a greater number of infectious diseases, in particular unusual microbial diseases like Cryptococcus, Salmonella, Listeria, etc., especially in low income community settings. Relating all of this to the past, Powell’s study tells us that during the early stages of the economic development of Clinton County that there were some diseases rampant for the time that may persist to this day, along with the vice versa–to better understand the diseases of the past in parts of Clinton County, we need only turn to the public health communicable disease studies of the present time to better understand what was happening more than a century ago, when the same sorts of lifestyles and occupations played a central role in what the people did for a living in Clinton County.
Population Pyramids and Projections for the county:
One possible lesson of all this that we can walk away with is as follows:
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Modern population settings, formed within an old-fashioned rural setting but lacking any significant economic and income development, retain many of the diseases of previous sequent occupancy stages.
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The older Stage 2 and early Stage 3 Sequent Occupancy settings with farming and a little bit of technical development results in a population setting prone to Stage 2 and 3 disease patterns, excluding those effectively reduced or prevented by such things as vaccination and public health laws.
(from my thesis – see other page)
Brian Altonen, MPH, MS 